The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.The AMA's stated mission is "to promote the art and science of medicine and the betterment of public health." The Association also publishes the Journal of the American Medical Association (JAMA). The AMA also publishes a list of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties.The American Medical Association is governed by a House of Delegates as well as a board of trustees in addition to executive management. The organization maintains the AMA Code of Medical Ethics, and the AMA Physician Masterfile containing data on United States Physicians. The Current Procedural Terminology coding system was first published in 1966 and is maintained by the Association. It has also published works such as the Guides to Evaluation of Permanent Impairment and established the American Medical Association Foundation and the American Medical Political Action Committee.Susan R. Bailey, the third consecutive female president of the AMA and an allergist and immunologist from Fort Worth, Texas, was sworn in as president in June 2020. The current president is Gerald E. Harmon, a family medicine physician from Pawleys Island, South Carolina.S.S.
Importance Exploring the relationship between moral distress and occupational burnout is necessary to understand the association between these constructs. Objective To evaluate moral distress among physicians and US workers, and to explore the association of moral distress with burnout, intent to leave (ITL) current position, and intent to reduce clinical work hours (ITR). Design, Setting, and Participants This cross-sectional national survey study included physicians from all specialties and a probability-based sample of employed nonphysicians. Participants were aged 29 to 65 years. Data were collected between October 19, 2023, and March 5, 2024. Data were analyzed from June 30 to October 20, 2025. Main Outcomes and Measures Moral distress was measured using the Moral Distress Thermometer (MDT, range 0-10), with a high level of moral distress defined by a score of 4 or higher. Burnout was measured using the complete Maslach Burnout Inventory (MBI). Professional fulfillment was measured using the Stanford Professional Fulfillment Index. ITL and ITR were measured using a standardized item with response options of none, slight, moderate, likely, and definitely. Results This survey study included 5741 physicians and 3501 nonphysician US workers. The median (IQR) age of physicians was 53 (44-62), and included 3262 men (58.0%), 2255 women (40.1%), and 107 individuals who responded other (1.9%). The mean (SD) moral distress score for physicians was 3.29 (2.81), with 2243 (39.1%) reporting a high level of moral distress (4 or more considered high). On multivariable analysis, women physicians had higher odds of moral distress (OR, 1.29; 95% CI, 1.12-1.48). Compared with internal medicine subspecialists, emergency medicine physicians (OR, 3.16; 95% CI, 2.27-4.4) and general internal medicine physicians (OR, 1.92; 95% CI, 1.42-2.59) were more likely to report high levels of moral distress. Mean emotional exhaustion and depersonalization scores, as well as the proportion of physicians with burnout, were higher with each 1-point increase in moral distress score. The overall correlation between the emotional exhaustion score and moral distress score was R = 0.55 (P < .001) while the correlation between the depersonalization score and moral distress score was R = 0.50 (P < .001). Additionally, 1068 of 3477 physicians (30.7%) with a moral distress score less than 4 had burnout symptoms compared with 1675 of 2231 physicians (75.1%) with scores of 4 or more (P < .001). The prevalence of ITL and ITR was higher for each 1-point increase in moral distress score. For example, 619 of 3404 physicians (18.2%) with low moral distress reported ITL within 24 months compared with 748 of 2171 (34.5%) among those with high moral distress (P < .001). Compared with other US workers, physicians had markedly higher odds of experiencing moral distress (OR, 4.40; 95% CI, 3.84-5.06). Conclusion and Relevance In this survey study, moral distress was common among physicians and experienced at higher rates than the general US working population. Understanding the differences between moral distress and burnout may allow organizations to more effectively implement interventions to address both concerns among clinicians.
Chest-binding is a common practice among transgender and gender-diverse youth, yet there are few studies on health promotion tools about healthy chest-binding practices directed to this population. This study overviews the creation of Breathe: Journeys to Healthy Binding and the evaluation of its effectiveness for promoting informed decision-making around chest binding in transgender and gender-diverse (TGD) individuals. In this mixed-methods pilot evaluation, participants (n=25) aged 18+ took a pretest survey measuring their knowledge around healthy binding practices before reading Breathe (provided in an online format), then took a posttest survey, re-measuring knowledge and measuring the zine's acceptability. Finally, participants joined focus groups to discuss how the zine affected their attitudes and behaviors around binding. Quantitative findings suggest the zine significantly increased participant knowledge about healthy chest binding practices and exercises to reduce side effects caused by binding, as well as increasing scores on healthy binding self-efficacy measures. Thematic analysis of the focus groups identified key themes in participants' reactions to the zine, including its characters, perceived utility, and intentions to change behavior after reading the zine. This study demonstrates how zines may be effective in shifting knowledge, attitudes, and behaviors in participants, particularly as a culturally congruent method of health communication for the transgender community.
Importance:A sense of belonging is a fundamental need that predicts mental, physical, social, economic, and behavioral outcomes. Experiencing a sense of belonging at work may be influenced by organizational culture and whether a person feels supported by teammates. There is little evidence of what proportion of physicians feel a strong sense of belonging and teammate support. There exists a gap in literature showing whether these factors are associated with burnout or work intentions, which leaves health care leaders without a valuable tool to improve professional well-being and workforce retention. Objective:To provide health care leaders with a better understanding of how fostering belonging and teammate support can decrease burnout and potentially prevent costly turnover. Design, Setting, and Participants:This cross-sectional study used data from a survey administered to physicians by their organization leaders as part of the organization's quality improvement efforts through participation in the American Medical Association Organizational Biopsy program. The survey was administered within health care organizations and health systems across the US with more than 50 physicians. The study population comprised physicians working in US-based health care organizations and health systems. Survey responses were collected between November 7, 2023, and November 12, 2024. Analysis was performed from June to August 2025. Main Outcomes and Measures:Belonging and teammate support perceptions were measured by asking participants to indicate how much they agree with 2 statements. Burnout was assessed using the single-item Mini Z assessment, and work intentions were indicated by likeliness to reduce clinical hours in the next 12 months or leave practice within the next 2 years. Odds ratios (ORs) and 95% CIs were used. Results:Of 14 051 physicians, 7315 were male (52.1%), 1978 were Asian (14.1%), 406 were Black or African American (2.9%), 425 were Latinx or Hispanic (3.0%), and 8681 were White (61.8%). Additionally, 4733 (33.7%) had 20 or more posttraining years of clinical practice and 4475 (31.8%) practiced in primary care. A strong sense of belonging was endorsed by 8425 (60.0%) and 11 293 (80.4%) perceived teammate support. Females (odds ratio [OR], 0.91, 95% CI, 0.84-0.98) and physicians with more than 5 years of clinical practice (eg, 6-10 years: OR, 0.76; 95% CI, 0.67-0.85; ≥20 years: OR, 0.87; 95% CI, 0.78-0.96) had lower odds of having strong sense of belonging. A strong sense of belonging was associated with lower odds of burnout (OR, 0.22; 95% CI, 0.21-0.24), lower odds of intent to reduce clinical hours (OR, 0.48; 95% CI, 0.44-0.53), and lower odds of intent to leave the organization (OR, 0.23; 95% CI, 0.21-0.26). Similar patterns were observed for factors associated with teammate support and for the association of teammate support with burnout, intent to reduce hours, and intent to leave the organization. Conclusions and Relevance:In this cross-sectional study of physicians in the US, a strong sense of belonging was associated with lower odds of burnout, intent to reduce clinical hours, and intent to leave the organization. These findings suggest that fostering belonging and teammate support can benefit physicians, care teams, patients, and organizations by potentially avoiding physician turnover. Organizations should prioritize belonging and teammate support in their efforts to improve culture, work environment, and physician well-being.
PURPOSE:Despite the movement toward competency-based medical education (CBME), most training programs in the United States still advance learners based on time-in-training rather than achievement of competency standards. The Education in Pediatrics Across the Continuum (EPAC) project sought to answer whether it is possible to make time-variable, competency-based advancement decisions by creating a program that spans undergraduate (UME) to graduate medical education (GME) to fellowship/practice. This article reports the outcomes of the EPAC project. METHOD:Each participating site (Universities of California-San Francisco, Colorado, Minnesota, and Utah) selected 4 consecutive cohorts and prospectively followed them from July 2013 to June 2023. Implementation allowed for site-variability but adhered to common design principles. The Core Entrustable Professional Activities (EPAs) for Entering Residency and the General Pediatrics EPAs were the competency frameworks. Each site convened a clinical competency committee every three to six months to determine readiness for learner transition from UME to GME and GME to practice/fellowship based on demonstrated competence. RESULTS:Fifty-six learners enrolled in EPAC and forty-four (79%) completed the program as designed. The time required for each learner to demonstrate readiness for transition from UME to GME (mean 20.2 four-week blocks [SD 2.76], range 14.5-26) and GME to practice/fellowship (mean 5.8 six-month blocks, [SD 0.34], range 4.9-6.1) varied. EPAC participants' educational outcomes were comparable to non-EPAC graduates at the same site, including Milestones ratings (B = 0.30, P = .21), first time pass rates for the American Board of Pediatrics initial certifying exam (93%, 95% CI 81%-98%), and attainment of fellowship or job placements after graduation. CONCLUSIONS:The outcomes of the EPAC project demonstrated the ability to make competency-based readiness-to-transition decisions for individual learners and is the first CBME program to span the UME/GME medical education continuum in the US. Lessons learned from the EPAC project have the potential to contribute to advancement efforts for CBME.
